I'm still waiting to be able to schedule my surgery, sad to report. But I'll give you a quick rundown. All the squeaky-wheel stuff got me a somewhat better response than a blatant denial from my employer. But after all that wasted time, they have presented me with a 3 page legal contract, stating that if I agree (to sign my life and rights away) they would cover 80%. Under different circumstances this would appear to be good news. Except that they are still pulling out the old "TMJ Disorder" exclusion as the reason they will not cover it completely. This makes me SO mad because it is otherwise stated that surgery for "congenital deformity" is a covered procedure - at 100%. So, now we're dealing with a "principle" issue. It would certainly be easier to take the offer and run with it, but then I'm knowingly letting them get away with something that is actually illegal. And they will continue to do this to people because they can. I'm stuck between a rock and a hard place. As bad as I just want to get the surgery over with ... I am SO a principles person. What I really want to do at this point is first get the surgery and just take them to court later. I know that I would win in the end, but it could take a few years (mind you, I am fully aware they will try to settle outside of court), but if they force my hand on this issue I have no intention of settling anything. I have extended one too many Olive branches already. I could have hired an attorney after the very first denial and been on my way, but I have tried to work something out internally before pursuing it in court. Ugh. What to do?
3 comments:
Wow. I wish I had experience with this sort of thing so I could offer some advice... Very frustrating I'm sure.
Good luck with all of this... I will be checking your blog for updates.
Do you have a lawyer yet? What does he/she suggest? I don't know what I would personally do.. maybe just take what they are offering me b/c I'd be too scared to challenge them and b/c like you said, I would just be happy they are finally giving me something (after this awful ordeal you have gone thru), but I don't necessarily think that is the "right" thing to do either. Very tough decision. I wish you the best of luck.
Wow you're a strong person to be prepared to take the insurance people on. Every best wish for whatever you do and most important to get your surgery taken care of 100%!
Good luck!
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